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Insurance Referral and Pre-certification Requirements

Company/Patient PlanType
 Insurance Referral and Pre-certification Requirements*
AARP
   NONE
Advantage Health
 HMO
 NONE
AETNA Healthcare
 HMO, POS, Qpos,
US access, Open Access
 Precertification required for MRI, MRA, CT, CTA, PET/CT, and Nuclear Medicine.
Pre-cert contact number: 800-918-8924
Pre-cert Web site: www.carecorenational.com
AETNA
 PPO
 NONE
AFSRA/Coventry
   Member should contact the home plan listed on back of the card for precertification guidance.
APWU
   Precertification required for MRI, MRA, CT, CTA, PET/CT, and Nuclear Medicine.
Pre-cert contact number: 888-693-3298
Bankers Life
   NONE
BC/BS CareFirst
Blue Choice
 HMO Blue Choice,
POS, Indemnity,
dual option, Anthem PPO, HMO
 Member should contact the home plan listed on back of the card for precertification guidance.
Pre-cert contact info: See phone number on back of insurance card
Pre-cert Web site: Varies by state
BC/BS Federal/Local
 PPO, Federal
 NONE
CIGNA
 HMO, Network, POS,
PPA, Open Access,
Open Access Plus,
Flexcare
 Precertification required for MRI, MRA, CT, CTA, PET/CT, Nuclear Medicine and HSG.
Pre-cert contact info: MedSolutions, 1-888-693-3211
DC residents: 800-541-7256
Pre-cert Web site: www.medsolutionsonline.com
CIGNA
 PPO
 NONE
CareFirst
   Member should contact the home plan listed on back of the card for precertification guidance.
Chartered Alliance/
Chartered Health Plan/Health Right/
Health Right Alliance
   Referral needed for all radiology procedures.
Pre-cert contact number: 202-408-4720
Crime Victims
   NONE
DC Medicaid
   Precertification required for PET/CT
Pre-cert contact number: DelMarVa, 410-712-7416
Precert contact number: 800-999-3362
ElderCare
 Medicare HMO
 Precertification required for MRI, MRA, CT, CTA, PET/CT, and Nuclear Medicine.
Pre-cert contact number: 800-556-1570
Pre-cert contact number (local): 410-864-4440
Embassy Liability
   NONE
FCE Benefit
Administrators
   Member should contact the home plan listed on back of the card for precertification guidance.
Pre-cert contact number: 800-962-0643
Mail Handlers
Coventry
   Member should contact the home plan listed on back of the card for precertification guidance.
Pre-cert contact number: 800-410-7778
Great West
   Member should contact the home plan listed on back of the card for precertification guidance.
Pre-cert contact number: 888-693-3295
HSCSN
   Precertification required for MRI, MRA, CT, CTA, PET/CT, and Nuclear Medicine.
Pre-cert contact number: 202-463-2737
Health Payors
Organization (HPO)
   NONE
Humana
   Precertification required for all Radiologic exams.
Pre-cert contact number: 800-523-0023
Kaiser Permanente
   Insurance referral required for all exams with the exception of screening mammograms.
Pre-cert contact number: 800-810-4766
MAMSI/MDIPA/GEHA/
Optimum Choice
   Precertification required for MRI, MRA, CT, CTA, PET/CT, and Nuclear Medicine.
Pre-cert contact number: 800-342-6141
GEHA Pre-cert contact number: 888-693-3298
MD Medicaid
   NONE
Medicare
   NONE
National Capital PPO
(Unicare)
   Precertification required for MRI, MRA, CT, CTA, PET/CT, and Nuclear Medicine.
Pre-cert contact number: 866-714-1101
NALC
   Member should contact the home plan listed on back of the card for precertification guidance.
Pre-cert contact info: 800-548-8454
One Net
 PPO
 Member should contact the home plan listed on back of the card for precertification guidance.
Pre-cert contact number: 800-342-6141
Peace Corps
   NONE
Principal Financial
Group
   NONE
Tricare
 PPO
 Member should contact the home plan listed on back of the card for precertification guidance.
Pre-cert Web site: www.mytricare.com
United HealthCare
of Mid-Atlantic
 POS, PPO
 Precertification required for MRI, MRA, CT, CTA, PET/CT, and Nuclear Medicine.
Pre-cert contact number: 866-889-8054
Pre-cert Web site: www.unitedhealthcareonline.com
Unison/Unison Alliance
   Precertification required for MRI, MRA, CT, CTA, PET/CT, and Nuclear Medicine.
Pre-cert contact number: 800-366-7304
Unicare
   Precertification required for MRI, MRA, CT, CTA, PET/CT, and Nuclear Medicine.
Pre-cert contact number: 866-714-1101
Pre-cert Web site: https://www.providerportal.com
VA Medicaid
   NONE
VAN BREDA
   Member should contact the home plan listed on back of the card for precertification guidance.
Pre-cert contact info: 800-962-6831
WAUSA Insurance
   Member should contact the home plan listed on back of the card for precertification guidance.
Pre-cert contact info: 800-537-6662
Well Care
 Medicare HMO
 Member should contact the home plan listed on back of the card for precertification guidance.
Pre-cert contact info: 866-235-2770
Workers Comp
   NONE

* Please be advised that this list is kept as up-to-date as possible but we recommend contacting your insurance provider and our Admitting Department at 202-715-4053 prior to your radiology appointment to confirm that you've met the requirements for your plan.

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